African American women exhibit similar adherence to intervention but lose less weight due to lower energy requirements
International Journal of Obesity (2014) 38, 1147–1152 J P DeLany

The observation that Black women lose less weight than White women during a weight loss program has been reported repeatedly. This paper describes a reduction in energy expenditure (EE) in Black women compared to White, despite apparently similar adherence to the elements of their weight loss program. The difference in energy expenditure was explained by a lower total daily EE and resting metabolic rate (RMR) adjusted for FFM in the Black women, although the decrease in RMR in response to weight loss was greater in Caucasian women. The conclusion that Black women may need more restrictive regimens for similar weight loss is very important for clinicians and makes the case stronger for highly individualized therapy in weight reduction programs. Further research is needed to confirm these findings, investigate whether similar differences are observed in other Ethnic groups, and identify the mechanisms of the lower EE.

Background:

African American (AA) women have been shown to lose less weight than Caucasian women in response to behavioral interventions. Our objective was to examine adherence to intervention and metabolic factors that may explain this difference.

Design and subjects:

We examined longitudinal changes in body weight and energy expenditure (EE), and objective assessment of physical activity (PA) and energy intake (EI) during 6 months of a weight-loss intervention program, including prescribed calorie restriction and increased PA in 66 Caucasian and 39 AA severely obese women. Comparisons were also made in 25 Caucasian and 25 AA women matched for initial body weight.

Results:

The AA women lost 3.6 kg less weight than Caucasian women. Total daily EE (TDEE) and resting metabolic rate (RMR) adjusted for fat free mass (FFM) were significantly lower in the AA women, whereas the decrease in RMR in response to weight loss was greater in Caucasian women. Adherence to the prescribed PA and change in PA in response to intervention were similar in AA and Caucasian women. Prescribed EI (1794±153 and 1806±153 kcal per day) and measured EI during intervention (2591±371 vs 2630±442 kcal per day) were nearly identical in matched AA and Caucasian women. However, the AA women lost significantly less body weight due to lower energy requirements (2924±279 vs 3116±340 kcal per day; P

Adherence to the behavioral intervention was similar in AA and Caucasian women. However, neglecting to account for the lower energy requirements in AA women when calculating the energy prescription resulted in a lower level of calorie restriction and, hence, less body weight loss. Therefore,

to achieve similar weight loss in AA women, the prescribed caloric restriction cannot be based on weight alone, but must be lower than in Caucasians, to account for lower energy requirements.